Part 4: Venous Thromboembolism

Elisabeth M. Battinelli, MD, PhD

Assistant Professor of Medicine, Harvard Medical School, Associate Physician, Division of Hematology, Brigham and Women's Hospital, Boston, MA

Jean M. Connors, MD

Assistant Professor of Medicine, Harvard Medical School, Medical Director, Anticoagulation Management Service, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA

Question 1

A 53-year-old woman presents to the emergency department with shortness of breath and chest pain that she describes as worse with inhalation. The patient states that her symptoms started acutely approximately 2 hours earlier while she was sitting at her desk in work. The womanís past medical history is unremarkable and she takes no medication except for hormone replacement therapy. The emergency medicine team caring for the patient orders a chest computed tomography (CT) angiogram, which reveals multiple bilateral pulmonary artery filling defects consistent with pulmonary embolism (PE). Doppler ultrasound of her leg veins reveals noncompressible popliteal vein of the left leg, suggestive of deep vein thrombosis (DVT). There is no family history of any thrombotic events in either her maternal or paternal family. The emergency medicine team initiates anticoagulation and orders laboratory testing for thrombophilia.

Which of the following statements regarding diagnosis at the time of this patientís acute thrombotic event is most accurate?

  •   It is highly likely the patient will have antiphospholipids present and
    therefore meets criteria for antiphospholipid syndrome
  •   The patient is highly likely to have inherited thrombophilia and
    therefore thrombophilia testing should be initiated immediately
  •   The patientís protein S level may be artificially elevated due to the
    exogenous estrogen she is ingesting
  •   The tests for thrombophilia should be performed as an outpatient
    once the patient is either on stable anticoagulation or off anticoagulation

Updated 11/21/2013 • jdw | Copyright ©2014 Turner White Communications